, Maternity Newborn and Women’s Health Nursing A Case-Based Approach 1st Edition f f f f f f f f f f
O’Meara Test Bank f f
Chapter 1 Immediate Postpartum Hemorrhage f f f f
MULTIPLE CHOICE f
1. A pregnant woman is being discharged from the hospital after the placement of a cervical
f f f f f f f f f f f f f f
cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix.
f f f f f f f f f f f f f f
Which information regarding postprocedural care should the nurse emphasize in the discharge
f f f f f f f f f f f f
teaching?
f
a. Any vaginal discharge should be immediately reported to her health care provider. f f f f f f f f f f f
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure shoul
f f f f f f f f f f f f f
c. The client will need to make arrangements for care at home, because her activity level will be restri
f f f f f f f f f f f f f f f f f
d. The client will be scheduled for a cesarean birth. f f f f f f f f
ANS: B
f f
Nursing care should stress the importance of monitoring for the signs and symptoms of preterm
f f f f f f f f f f f f f f
labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest is an
f f f f f f f f f f f f f f f f
element of care. However, the woman may stand for periods of up to 90 minutes, which allows her
f f f f f f f f f f f f f f f f f f
the freedom to see her physician. Home uterine activity monitoring may be used to limit the
f f f f f f f f f f f f f f f f
womans need for visits and to monitor her status safely at home. The cerclage can be removed at 37
f f f f f f f f f f f f f f f f f f f
weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.
f f f f f f f f f f f f f f f f
DIF: Cognitive Level: Apply REF: dm. 675
f f f f f f
TOP: Nursing Process: Planning | Nursing Process: Implementation
f f f f f f f
MSC: Client Needs: Health Promotion and Maintenance
f f f f f f f
2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage
f f f f f f f f f f f f f
secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the
f f f f f f f f f f f f f f f f
next 12 months. What is the bestresponse by the nurse?
f f f f f f f f f f
If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if
f f f f f f f f f f f f f f f f f
a. pregnancy, it would be better for you to use the most reliable method of contraception available. f f f f f f f f f f f f f f f
The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by me
f f f f f f f f f f f f f f f f f f f f
hormone that your body produces during pregnancy. If you were to get pregnant, then it would mak
f f f f f f f f f f f f f f f f
b. this cancer more difficult. f f f
If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy
f f f f f f f f f f f f f f f f f
c. improve your chance of a successful pregnancy, not getting pregnant at this time is best.
f f f f f f f f f f f f f f
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar preg f f f f f f f f f f f f f f f f f
ANS: B
f f
Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure
f f f f f f f f f f f f
that the mole is completely gone. The chance of developing choriocarcinoma after the
f f f f f f f f f f f f
development of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human
f f f f f f f f f f f f f f f f
chorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscure
f f f f f f f f f f f f f f f
the presence of the potentially carcinogenic cells. Women should be instructed to use birth control
f f f f f f f f f f f f f f f
for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy
f f f f f f f f f f f f f f
,for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an
f f f f f f f f f f f f f f f f
intrauterine device (IUD) is acceptable.
f f f f f
DIF: Cognitive Level: Apply REF: dm. 679
f f f f f f
TOP: Nursing Process: Planning | Nursing Process: Implementation
f f f f f f f
MSC: Client Needs: Physiologic Integrity
f f f f f
3. The nurse is preparing to administer methotrexate to the client. This hazardous drug is
f f f f f f f f f f f f f
most often used for which obstetric complication?
f f f f f f f
a. Complete hydatidiform mole f f
b. Missed abortion f
c. Unruptured ectopic pregnancy f f
d. Abruptio placentae f
ANS: C
f f
Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman
f f f f f f f f f f f
whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate is
f f f f f f f f f f f f f f
not indicated or recommended as a treatment option for a complete hydatidiform mole, for a
f f f f f f f f f f f f f f f
missed abortion, or for abruptio placentae.
f f f f f f
DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process: Planning MSC:
f f f f f f f f f f f
Client Needs: Physiologic Integrity
f f f f
4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she
f f f f f f f f f f f f f
experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic
f f f f f f f f f f f f f f
procedure will the client most likely have performed?
f f f f f f f f
a. Amniocentesis for fetal lung maturity f f f f
b. Transvaginal ultrasound for placental location f f f f
c. Contraction stress test (CST) f f f
d. Internal fetal monitoring f f
ANS: B
f f
The presence of painless bleeding should always alert the health care team to the possibility of
f f f f f f f f f f f f f f f
placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not
f f f f f f f f f f
performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the
f f f f f f f f f f f f f f f f
fetus is presumed to have immature lungs at this gestational age, and the mother is given
f f f f f f f f f f f f f f f f
corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age.
f f f f f f f f f f f f f f f f f
Furthermore, bleeding is a contraindication to a CST. Internal fetal monitoring is also
f f f f f f f f f f f f f
contraindicated in the presence of bleeding.
f f f f f f
DIF: Cognitive Level: Apply REF: dm. 680
f f f f f f
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
f f f f f f f f f f
5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
f f f f f f f f f f f f
fluid consists of bright red blood. Her contractions are consistent with her current stage of labor.
f f f f f f f f f f f f f f f f
No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline
f f f f f f f f f f f f f f f f
rapidly after the ROM. The nurse should suspect the possibility of what condition?
f f f f f f f f f f f f f
a. Placenta previa f
b. Vasa previa f
c. Severe abruptio placentae f f
, d. Disseminated intravascular coagulation (DIC) f f f
ANS: B
f f
Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels
f f f f f f f f f f f f f f f
are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels
f f f f f f f f f f f f f f
thus are at risk for laceration at any time, but laceration occurs most frequently during ROM. The
f f f f f f f f f f f f f f f f f
sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR
f f f f f f f f f f f f f f f f f f
without other known risk factors should immediately alert the nurse to the possibility of vasa
f f f f f f f f f f f f f f f
previa. The presence of placenta previa most likely would be ascertained before labor and is
f f f f f f f f f f f f f f f
considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is
f f f f f f f f f f f f f f f f f f
unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe
f f f f f f f f f f f f f f f f f f
abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a
f f f f f f f f f f f f f f f
pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing
f f f f f f f f f f f f f
widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis,
f f f f f f f f f f f f f
often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels, and
f f f f f f f f f f f f f f f
low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.
f f f f f f f f f f f f f f
DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process: Diagnosis
f f f f f f f f f f
MSC: Client Needs: Physiologic Integrity
f f f f f
6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal
f f f f f f f f f f f f f f
fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an
f f f f f f f f f f f f f
ecchymotic blueness around the womans umbilicus. What does this finding indicate?
f f f f f f f f f f f
a. Normal integumentary changes associated with pregnancy f f f f f
b. Turner sign associated with appendicitis f f f f
c. Cullen sign associated with a ruptured ectopic pregnancy f f f f f f f
d. Chadwick sign associated with early pregnancy f f f f f
ANS: C
f f
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
f f f f f f f f f f f
associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the
f f f f f f f f f f f
abdomen is the normal integumentary change associated with pregnancy and exhibits a brown
f f f f f f f f f f f f f
pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area, often
f f f f f f f f f f f f f f f f
associated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen during or
f f f f f f f f f f f f f f f f
around the eighth week of pregnancy.
f f f f f f
DIF: Cognitive Level: Analyze REF: dm. 676
f f f f f f
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
f f f f f f f f
7. The nurse who elects to practice in the area of womens health must have a thorough
f f f f f f f f f f f f f f f
understanding of miscarriage. Which statement regarding this condition is most accurate?
f f f f f f f f f f f
a. A miscarriage is a natural pregnancy loss before labor begins. f f f f f f f f f
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
f f f f f f f f f f
c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causing
f f f f f f f f f f f f f f f
a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as modera
f f f f f f f f f f f f f f f f f
d. blood loss. f
ANS: D f
Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week,
f f f f f f f f f f f f f f f f
more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it
f f f f f f f f f f f f f f f f f f
O’Meara Test Bank f f
Chapter 1 Immediate Postpartum Hemorrhage f f f f
MULTIPLE CHOICE f
1. A pregnant woman is being discharged from the hospital after the placement of a cervical
f f f f f f f f f f f f f f
cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix.
f f f f f f f f f f f f f f
Which information regarding postprocedural care should the nurse emphasize in the discharge
f f f f f f f f f f f f
teaching?
f
a. Any vaginal discharge should be immediately reported to her health care provider. f f f f f f f f f f f
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure shoul
f f f f f f f f f f f f f
c. The client will need to make arrangements for care at home, because her activity level will be restri
f f f f f f f f f f f f f f f f f
d. The client will be scheduled for a cesarean birth. f f f f f f f f
ANS: B
f f
Nursing care should stress the importance of monitoring for the signs and symptoms of preterm
f f f f f f f f f f f f f f
labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest is an
f f f f f f f f f f f f f f f f
element of care. However, the woman may stand for periods of up to 90 minutes, which allows her
f f f f f f f f f f f f f f f f f f
the freedom to see her physician. Home uterine activity monitoring may be used to limit the
f f f f f f f f f f f f f f f f
womans need for visits and to monitor her status safely at home. The cerclage can be removed at 37
f f f f f f f f f f f f f f f f f f f
weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.
f f f f f f f f f f f f f f f f
DIF: Cognitive Level: Apply REF: dm. 675
f f f f f f
TOP: Nursing Process: Planning | Nursing Process: Implementation
f f f f f f f
MSC: Client Needs: Health Promotion and Maintenance
f f f f f f f
2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage
f f f f f f f f f f f f f
secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the
f f f f f f f f f f f f f f f f
next 12 months. What is the bestresponse by the nurse?
f f f f f f f f f f
If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if
f f f f f f f f f f f f f f f f f
a. pregnancy, it would be better for you to use the most reliable method of contraception available. f f f f f f f f f f f f f f f
The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by me
f f f f f f f f f f f f f f f f f f f f
hormone that your body produces during pregnancy. If you were to get pregnant, then it would mak
f f f f f f f f f f f f f f f f
b. this cancer more difficult. f f f
If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy
f f f f f f f f f f f f f f f f f
c. improve your chance of a successful pregnancy, not getting pregnant at this time is best.
f f f f f f f f f f f f f f
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar preg f f f f f f f f f f f f f f f f f
ANS: B
f f
Betahuman chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure
f f f f f f f f f f f f
that the mole is completely gone. The chance of developing choriocarcinoma after the
f f f f f f f f f f f f
development of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human
f f f f f f f f f f f f f f f f
chorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscure
f f f f f f f f f f f f f f f
the presence of the potentially carcinogenic cells. Women should be instructed to use birth control
f f f f f f f f f f f f f f f
for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy
f f f f f f f f f f f f f f
,for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an
f f f f f f f f f f f f f f f f
intrauterine device (IUD) is acceptable.
f f f f f
DIF: Cognitive Level: Apply REF: dm. 679
f f f f f f
TOP: Nursing Process: Planning | Nursing Process: Implementation
f f f f f f f
MSC: Client Needs: Physiologic Integrity
f f f f f
3. The nurse is preparing to administer methotrexate to the client. This hazardous drug is
f f f f f f f f f f f f f
most often used for which obstetric complication?
f f f f f f f
a. Complete hydatidiform mole f f
b. Missed abortion f
c. Unruptured ectopic pregnancy f f
d. Abruptio placentae f
ANS: C
f f
Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman
f f f f f f f f f f f
whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate is
f f f f f f f f f f f f f f
not indicated or recommended as a treatment option for a complete hydatidiform mole, for a
f f f f f f f f f f f f f f f
missed abortion, or for abruptio placentae.
f f f f f f
DIF: Cognitive Level: Apply REF: dm. 677 TOP: Nursing Process: Planning MSC:
f f f f f f f f f f f
Client Needs: Physiologic Integrity
f f f f
4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she
f f f f f f f f f f f f f
experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic
f f f f f f f f f f f f f f
procedure will the client most likely have performed?
f f f f f f f f
a. Amniocentesis for fetal lung maturity f f f f
b. Transvaginal ultrasound for placental location f f f f
c. Contraction stress test (CST) f f f
d. Internal fetal monitoring f f
ANS: B
f f
The presence of painless bleeding should always alert the health care team to the possibility of
f f f f f f f f f f f f f f f
placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not
f f f f f f f f f f
performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the
f f f f f f f f f f f f f f f f
fetus is presumed to have immature lungs at this gestational age, and the mother is given
f f f f f f f f f f f f f f f f
corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age.
f f f f f f f f f f f f f f f f f
Furthermore, bleeding is a contraindication to a CST. Internal fetal monitoring is also
f f f f f f f f f f f f f
contraindicated in the presence of bleeding.
f f f f f f
DIF: Cognitive Level: Apply REF: dm. 680
f f f f f f
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
f f f f f f f f f f
5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The
f f f f f f f f f f f f
fluid consists of bright red blood. Her contractions are consistent with her current stage of labor.
f f f f f f f f f f f f f f f f
No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline
f f f f f f f f f f f f f f f f
rapidly after the ROM. The nurse should suspect the possibility of what condition?
f f f f f f f f f f f f f
a. Placenta previa f
b. Vasa previa f
c. Severe abruptio placentae f f
, d. Disseminated intravascular coagulation (DIC) f f f
ANS: B
f f
Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels
f f f f f f f f f f f f f f f
are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels
f f f f f f f f f f f f f f
thus are at risk for laceration at any time, but laceration occurs most frequently during ROM. The
f f f f f f f f f f f f f f f f f
sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR
f f f f f f f f f f f f f f f f f f
without other known risk factors should immediately alert the nurse to the possibility of vasa
f f f f f f f f f f f f f f f
previa. The presence of placenta previa most likely would be ascertained before labor and is
f f f f f f f f f f f f f f f
considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is
f f f f f f f f f f f f f f f f f f
unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe
f f f f f f f f f f f f f f f f f f
abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a
f f f f f f f f f f f f f f f
pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing
f f f f f f f f f f f f f
widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis,
f f f f f f f f f f f f f
often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels, and
f f f f f f f f f f f f f f f
low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.
f f f f f f f f f f f f f f
DIF: Cognitive Level: Analyze REF: dm. 684 TOP: Nursing Process: Diagnosis
f f f f f f f f f f
MSC: Client Needs: Physiologic Integrity
f f f f f
6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal
f f f f f f f f f f f f f f
fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an
f f f f f f f f f f f f f
ecchymotic blueness around the womans umbilicus. What does this finding indicate?
f f f f f f f f f f f
a. Normal integumentary changes associated with pregnancy f f f f f
b. Turner sign associated with appendicitis f f f f
c. Cullen sign associated with a ruptured ectopic pregnancy f f f f f f f
d. Chadwick sign associated with early pregnancy f f f f f
ANS: C
f f
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
f f f f f f f f f f f
associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the
f f f f f f f f f f f
abdomen is the normal integumentary change associated with pregnancy and exhibits a brown
f f f f f f f f f f f f f
pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area, often
f f f f f f f f f f f f f f f f
associated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen during or
f f f f f f f f f f f f f f f f
around the eighth week of pregnancy.
f f f f f f
DIF: Cognitive Level: Analyze REF: dm. 676
f f f f f f
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
f f f f f f f f
7. The nurse who elects to practice in the area of womens health must have a thorough
f f f f f f f f f f f f f f f
understanding of miscarriage. Which statement regarding this condition is most accurate?
f f f f f f f f f f f
a. A miscarriage is a natural pregnancy loss before labor begins. f f f f f f f f f
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
f f f f f f f f f f
c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causing
f f f f f f f f f f f f f f f
a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as modera
f f f f f f f f f f f f f f f f f
d. blood loss. f
ANS: D f
Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week,
f f f f f f f f f f f f f f f f
more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it
f f f f f f f f f f f f f f f f f f
